NPIMap

Organization Active NPI

Northeast Missouri Health Council, Inc.

Doing business as Northeast Behavioral Health

  • Federally Qualified Health Center (FQHC)
  • Kirksville, MO
National Provider Identifier
1083897292
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Doing business as
Northeast Behavioral Health
Practice address
105 Pfeiffer Ave
Kirksville, MO 63501-5047
Phone
(660) 627-3621
Fax
(660) 627-5798
NPI assigned
Dec 11, 2007
Last updated
Jun 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew H Grimm
Title
Executive Director
Phone
(660) 627-5757

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MO Primary
Social Worker 104100000X 2003016131 MO

Addresses

Primary practice location

105 Pfeiffer Ave
Kirksville, MO 63501-5047

Mailing address

1416 Crown Dr
Kirksville, MO 63501-2548
Phone (660) 627-5757

Other identifiers 1

IdentifierTypeStateIssuer
503351884MedicaidMO

Other names 1

  • Northeast Behavioral Health Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308268800000",
    "number": "1083897292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 CROWN DR",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635012548",
            "telephone_number": "660-627-5757",
            "fax_number": "660-627-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PFEIFFER AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635015047",
            "telephone_number": "660-627-3621",
            "fax_number": "660-627-5798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MISSOURI HEALTH COUNCIL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2011-06-17",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "660-627-5757"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2003016131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503351884",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.